Success of airway management in out-of-hospital cardiac arrest using different devices - a prospective, single-center, observational study comparing professions

Abstract Background Endotracheal intubation is the gold standard for airway management in out-of-hospital cardiopulmonary resuscitation (CPR) but requires practice, especially in difficult conditions. To facilitate this, video laryngoscopy (VL) is increasingly used. The extent to which it is actually used in practice by paramedics or emergency physicians (EPs) and its effectiveness remain unclear. This prospective observational study investigates these aspects. Methods From January 2020 to June 2024, we surveyed emergency physicians and paramedics in a German county about out-of-hospital resuscitations. The questionnaire covered qualifications, airway devices, attempts, and complications. Data was analyzed descriptively and statistically. The significance level was set at alpha ≤ 0.05. Results 301 questionnaires were analyzed, with an overall first pass success (FPS) rate of 62.8%. No significant difference was found between direct laryngoscopy (DL) and video laryngoscopy (VL), though VL with McGrath performed worse than DL and VL with C-Mac. FPS rates did not differ significantly between emergency physicians and paramedics. Both achieved better results with their regularly used device. Paramedics used laryngeal masks more frequently (34% vs. 1.5%, p